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Consent: Reversal of a Stoma

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Last updated: December 9, 2021
Revisions: 8

Last updated: December 9, 2021
Revisions: 8

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This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

Loop stomas are formed where faecal diversion is required to protect and defunction the down-stream bowel. Common reasons include a loop ileostomy as part of an anterior resection of the rectum (to reduce the morbidity of an anastomotic leak) or a loop colostomy for severe peri-anal Crohn’s disease.

The advantage of a loop stoma is that they can be reversed without needing a full repeat laparotomy*. The stoma is freed up by dissecting around the stoma at the original trephine site to the peritoneum and then rejoined by either a handsewn or staples anastomosis

The key point in the consent is to emphasise that this procedure is almost always done to improve quality of life rather than as a life-saving procedure.

*Reversal of an end stoma can also be performed, however often warrants a full laparotomy as the other end of the bowel is not as easily accessible as with a loop stoma

 

Complications

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Ensure meticulous haemostasis during the procedure
Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

 

Early

Complication Description of Complication Potential Ways to Reduce Risk
Infection Includes both wound infections and intra-abdominal collections, as well as respiratory or urinary tract infections post-operatively Intravenous antibiotics at induction, minimisation of faecal contamination during procedure, use of a “purse-string” suture to keep the wound site partially open
Anastomotic leak The rate is around 1-2%. If it occurs, this will frequently require re-operation and re-formation of the stoma (which will then most likely be permanent) Good blood supply at the anastomosis, bowel not under tension
Re-Operation Any complication may result in the return to theatre in the immediate post-operative period
DVT or PE, Myocardial Infarction, Stroke, or Mortality As with any major surgery, whilst these events are uncommon, they are complication important to emphasise to the patient Adequate pre-optimisation and anaesthetic assessment, peri-operative prophylactic LMWH, high-dependency level care post-operatively

 

Late

Complication Description of Complication Potential Ways to Reduce Risk
Incisional hernia Incisional hernia can occur through the closed defect Small bites technique to close the sheath
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